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Guidelines for investigating chemical process incidents.
This book provides a valuable reference tool for technical and management personnel who lead or are a part of incident investigation teams. This second edition focuses on investigating process-related incidents with real or potential catastrophic consequences. It presents on-the-job information, tec...
| Clasificación: | Libro Electrónico |
|---|---|
| Autor Corporativo: | |
| Formato: | Electrónico eBook |
| Idioma: | Inglés |
| Publicado: |
New York :
American Institute of Chemical Engineers,
©2003.
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| Edición: | 2nd ed. |
| Temas: | |
| Acceso en línea: | Texto completo |
Tabla de Contenidos:
- Guidelines for Investigating Chemical Process Incidents; Contents; Preface; Acknowledgments; 1 Introduction; 1.1. Building on the Past; 1.2. Who Should Read This Book?; 1.3. The Guideline's Objectives; 1.4. The Continuing Evolution of Incident Investigation; 2 Designing an Incident Investigation Management System; 2.1. Preplanning Considerations; 2.1.1. An Organization's Responsibilities; 2.1.2. The Benefits of Management's Commitment; 2.1.3. The Role of the Developers; 2.1.4. Integration with Other Functions and Teams; 2.1.5. Regulatory and Legal Issues; 2.2. Typical Management System Topics.
- 2.2.1. Classifying Incidents2.2.2. Other Options for Establishing Classification Criteria; 2.2.3. Specifying Documentation; 2.2.4. Describing Team Organization and Functions; 2.2.5. Setting Training Requirements; 2.2.6. Emphasizing Root Causes; 2.2.7. Developing Recommendations; 2.2.8. Fostering a Blame-Free Policy; 2.2.9. Implementing the Recommendations and Follow-up Activities; 2.2.10. Resuming Normal Operation and Establishing Restart Criteria; 2.2.11. Providing a Template for Formal Reports; 2.2.12. Review and Approval; 2.2.13. Planning for Continuous Improvement.
- 2.3. Implementing the Management System2.3.1. Initial Implementation-Training; 2.3.2. Initial Implementation-Data Management System; References; 3 An Overview of Incident Causation Theories; 3.1. Stages of a Process-Related Incident; 3.1.1. Three Phases of Process-Related Incidents; 3.1.2. The Importance of Latent Failures; 3.2. Theories of Incident Causation; 3.2.1. Domino Theory of Causation; 3.2.2. SystemTheory; 3.2.3. Hazard-Barrier-Target Theory; 3.3. Investigation's Place in Controlling Risk; 3.4. Relationship between Near Misses and Incidents; Endnotes.
- 4 An Overview of Investigation Methodologies4.1. Historical Approach; 4.2. Modern Structured Approach; 4.3. Methodologies Used by CCPS Members; 4.4. Description of Tools; 4.4.1. Brainstorming; 4.4.2. Timelines; 4.4.3. Sequence Diagrams; 4.4.4. Causal Factor Identification; 4.4.5. Checklists; 4.4.6. Predefined Trees; 4.4.7. Team-Developed Logic Trees; 4.5. Selecting an Appropriate Methodology; Endnotes; 5 Reporting and Investigating Near Misses; 5.1. Defining a Near Miss; 5.2. Obstacles to Near Miss Reporting and Recommended Solutions; 5.2.1. Fear of Disciplinary Action.
- 5.2.2. Fear of Embarrassment5.2.3. Lack of Understanding: Near Miss versus Nonincident; 5.2.4. Lack of Management Commitment and Follow-through; 5.2.5. High Level of Effort to Report and Investigate; 5.2.6. Disincentives for Reporting Near Misses; 5.2.7. Not Knowing Which Investigation System to Use; 5.3. Legal Aspects; Endnotes; 6 The Impact of Human Factors; 6.1. Defining Human Factors; 6.2. Human Factors Concepts; 6.2.1. Skills-Rules-Knowledge Model; 6.2.2. Human Behavior; 6.3. Incorporating Human Factors into the Incident Investigation Process; 6.3.1. Finding the Causes.